Introduction: Prevalence estimates for total diabetes were 10.3% in 2001–2004 and 13.2% in 2017–2020 (1). Diabetic foot ulcer is a major complication of diabetes. Every year in the United States, there are 150,000 amputations (2), with a majority of people with diabetes. People with diabetes are 30 times at risk for amputation compared to people without diabetes (3). Transmetatarsal amputation (TMA) is done to save people from major amputation. Failed TMA often leads to major amputations. Lisfranc amputation (LFA) and Chopart amputations (CPA) are controversial but have been used to avert major amputations (4). We aim to show LFA and CPA can allow patients to ambulate after healing.
Methods: We present a female patient with a past medical history significant for type 2 Diabetes with polyneuropathy and retinopathy, hyperlipidemia, chronic kidney disease, and homelessness. The patient developed osteomyelitis on both lower extremities. TMA failed in both feet. The patient did not want major amputation; we did more proximal midfoot amputation to salvage the limbs.
Results: Facing major amputations on both sides, the patient had a successful right LFA and a left CPA. After healing, she could ambulate short distances, even without a prosthesis. The patient was able to ambulate short distances even without proper prostheses.
Discussion: In many cases, a failed TMA leads to below-knee amputation or above-knee amputation. Depending on the severity of the infection or ischemia and the status of blood flow, LFA and CPA offer the alternative to major amputation. Surgeons should consider these rarely used procedures.
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